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Early Brain Injury, an Evolving Frontier in Subarachnoid Hemorrhage Research

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Abstract

Subarachnoid hemorrhage (SAH), predominantly caused by a ruptured aneurysm, is a devastating neurological disease that has a morbidity and mortality rate higher than 50 %. Most of the traditional in vivo research has focused on the pathophysiological or morphological changes of large arteries after intracisternal blood injection. This was due to a widely held assumption that delayed vasospasm following SAH was the major cause of delayed cerebral ischemia and poor outcome. However, the results of the CONSCIOUS-1 trial implicated some other pathophysiological factors, independent of angiographic vasospasm, in contributing to the poor clinical outcome. The term early brain injury (EBI) has been coined and describes the immediate injury to the brain after SAH, before onset of delayed vasospasm. During the EBI period, a ruptured aneurysm brings on many physiological derangements such as increasing intracranial pressure, decreased cerebral blood flow, and global cerebral ischemia. These events initiate secondary injuries such as blood–brain barrier disruption, inflammation, and oxidative cascades that all ultimately lead to cell death. Given the fact that the reversal of vasospasm does not appear to improve patient outcome, it could be argued that the treatment of EBI may successfully attenuate some of the devastating secondary injuries and improve the outcome of patients with SAH. In this review, we provide an overview of the major advances in EBI after SAH research.

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Acknowledgments

This study was partially supported by grants from the National Institutes of Health NS 053407 to JHZ.

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We declare that we have no conflicts of interest.

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Authors and Affiliations

  1. Department of Neurosurgery, Loma Linda University, School of Medicine, 11234 Anderson Street, Room 2562B, Loma Linda, CA, 92354, USA

    John H. Zhang

  2. Department of Physiology, Loma Linda University, Loma Linda, CA, 92354, USA

    Mutsumi Fujii, Junhao Yan, William B. Rolland, Yoshiteru Soejima, Basak Caner & John H. Zhang

  3. Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA, 92354, USA

    John H. Zhang

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  1. Mutsumi Fujii
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  2. Junhao Yan
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  3. William B. Rolland
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  4. Yoshiteru Soejima
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  5. Basak Caner
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  6. John H. Zhang
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Correspondence to John H. Zhang.

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Fujii, M., Yan, J., Rolland, W.B. et al. Early Brain Injury, an Evolving Frontier in Subarachnoid Hemorrhage Research. Transl. Stroke Res. 4, 432–446 (2013). https://doi.org/10.1007/s12975-013-0257-2

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  • DOI: https://doi.org/10.1007/s12975-013-0257-2

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